US News’s hospital rankings out -- CT performance disappointing

CT hospitals did not fare particularly well in the new 2011 US News hospital rankings. None ranked in the Honor Roll of best hospitals nationally. Only two of 47 total CT hospitals ranked nationally in any specialty – Yale New Haven #8 in diabetes and endocrinology and #7 in pediatrics: diabetes and endocrinology, and CT Children’s Medical Center #27 in pediatrics: orthopedics. In the Hartford area, Hartford Hospital and CCMC lead the pack. Ellen Andrews

News roundup

Hospital mergers accelerate Hartford Courant Hospitals working to reduce readmissions CT Mirror HUSKY improving with PCCM CT Health I-Team CT hospitals’ contribution to the economy CT News Junkie CT physicians’ contribution to the economy Hartford Business Journal Brokers’ role in health reform CT Mirror

Video on impact of ACA in CT

A new video from Rep. Joe Courtney, CTHPP Board member, shows real patients and doctors describing the important benefits of the Affordable Care Act on CT residents, providers and small businesses right now.

CSG/ERC health policy webinar

Join Stan Dorn of the Urban Institute for a webinar about the Basic Health Program option for states under the national Affordable Care Act. The webinar will be Monday, April 4th at noon. To register, go to https://www1.gotomeeting.com/register/191056697. The Basic Health Program option can allow states to continue to cover higher income parents who have been enrolled in Medicaid in comprehensive coverage that mirrors their current coverage at lower cost to both states and families than shifting them into the new health insurance exchanges. Stan’s recent paper on the Basic Health Program Option is at http://www.rwjf.org/coverage/product.jsp?id=72024. CT’s SustiNet plan includes exercising the Basic Health Program option for our state.

Single payer reform moves forward in VT

This week I was in Montpelier for a CSG/Eastern Region state capitol visit. House committees were debating their single payer reform bill, H202. Virtually all the discussion revolves around how to do it, not whether to do it. More than once I heard policymakers remark that this is a huge undertaking, but “we have to do it”. At a press conference a small business owner said that health benefits for his 52 employees have risen between 11 and 30 percent each year for the last decade. He hasn’t been able to increase wages, only continue offering health benefits. He said “H202 is an economic development bill dressed up as health care reform.”
They are beginning by setting up the framework to implement in 2017. Discussions this week revolved around timing and governance and staffing for the Green Mountain Care Board that will shepherd the plan. Questions included whether the Board should include one member from each stakeholder group (this is how we usually structure such things in CT, groups become massive and unwieldy and we get gridlock over and over – they quickly dismissed this idea), people with relevant expertise (health care finance, policy, etc.) or a set of good, smart people with guidance about working toward the greater good. Questions also revolved around the wisdom of ceding control of a large public trust to a non-elected board (similar to our SustiNet debate). Answers included that this happens in other areas, such as utility rate setting, and that this will be a law and can be changed by lawmakers if necessary.
Vermonters – legislators, staff, agency staff, advocates – are all exceptionally smart, knowledgeable about health policy as well as how it operates in the real world. Among them, Anya Rader Wallack who worked on our SustiNet plan, is leading the effort for the Governor’s office. I feel so much better after these trips – it’s restorative – kind of a spa trip for policy geeks.
Next week – New Hampshire.
Ellen Andrews

Getting health information exchange right

Anyone who shows up in an ER unconscious wants to know that the doctors treating them have all the information they need to make them well. It is also critical to keeping health costs down and reducing duplicate testing. But a proposed opt-out policy could jeopardize all that. An OP-ED by Helen George highlights the problems in this proposal which would default every state resident into the system without their consent. Providers would be responsible for deleting any legally-protected sensitive information from every record – an unreasonable burden on already busy practices and a huge liability. Sharing information for CT residents trying to access care in neighboring states will be complicated. It just won’t work. But worst of all, without the public’s trust the exchange won’t work, and being able to control our own private information is the foundation of public trust. In MA 90% of patients understand the benefits and agree to participate in their exchange. CT patients deserve the same respect and security. A bill to fix this proposal, require consent, and make the exchange viable is being heard by the Human Services Committee on Thursday. Thank you Helen.
Ellen Andrews

Medicaid Council and PCCM updates

At Friday morning’s Medicaid Council meeting we heard from Mercer about their HUSKY quality review project. The authors pointed out that most of the measures were about paperwork, not outcome-based, and of limited usefulness. For example, the study measured the reading level of member handbooks but not whether any members actually received or used them. The authors were eager to get input on how to make future reporting more meaningful. Despite its drawbacks the report’s review of coordination and continuity of care was helpful – especially as PCCM and care coordination will become a focus of the program going forward.

“Aetna does not have a process in place to require PCPs to develop a treatment
plan as required by the contract between Aetna and DSS.”

AmeriChoice’s care coordination appears to focus only on identifying enrollees with other coverage to ensure that other payers are paying their share.

“However no documentation of processes were provided. The current process
appears to be more reactive than proactive in nature.”

CHN was not assessed in 2010 as they met the care coordination standards in 2009. Hopefully these performance reviews will be considered in choosing an ASO for the program going forward.

In very good news, DSS provided new, internally-generated HEDIS plan performance reporting on a variety of measures. While the program is changing radically next January, this is important benchmark information to judge and track progress under the new ASO/PCCM model. It is critical to know where we’ve been to figure out how to improve. The Council applauded the team of analysts at DSS that has developed this long-needed capacity.

At the PCCM committee meeting Friday afternoon we also learned that the dreaded PCCM evaluation has been re-tooled to become a constructive, qualitative study meant to identify barriers to implementation, not as a comparison with the current program. All agreed that with only 516 current PCCM members, no meaningful comparison is possible.

Unfortunately we also learned that does not DSS intend to build on prior collaborative, constructive, diverse planning processes that developed the current PCCM policies, but to start over from scratch in a lengthy process to add more bells and whistles to the program. Advocates and legislative leadership urged the department to continue to build on the foundational current program structure, which was highlighted in the administration’s ASO/PCCM announcement and enjoys strong provider, consumer and legislative support, while they are planning future improvements. Deep concerns were raised about a loss of momentum, and damage to future collaboration, if implementation of PCCM is further delayed. Concerns were also raised that delaying full PCCM implementation would jeopardize CT’s ability to access 90% federal health home matching funds for care coordination services. States only receive those funds for 2 years (eight quarters); if we start the clock ticking with the current 516 enrollees, we will squander an important opportunity to secure federal resources for care coordination. CMS has indicated willingness, eagerness even, to advocates to work with CT in applying the 90% match health home option to our PCCM program.
Ellen Andrews

FAQs about patient-centered medical homes in CT

As part of discussion of national health reform and SustiNet, questions have been raised about patient-centered medical homes (PCMHs) in our state. We have drafted responses to some of those questions including:What is a patient centered medical home? (Coordinated care delivered by a team that helps patients keep themselves healthy)

• What is a patient centered medical home? (Coordinated care delivered by a team that helps patients keep themselves healthy)
• Do patient-centered medical homes save money? (Yes)
• Does CT have any patient centered medical homes? (Yes, 82 of them to date)
• Is there funding for patient-centered medical homes in federal health reform? (Yes)
  Ellen Andrews

MA health reforms did not reduce medical bankruptcies

A new study finds that health reform in MA, including the individual mandate, did little to reduce bankruptcies due to medical bills. The number of medical bankruptcies grew from 7,504 in 2007 to 10,093 in 2009; the proportion of bankruptcies due to medical bills dipped insignificantly from 59.3% to 52.9%. Insurance is not enough -- almost nine of ten debtors and their dependents had insurance at the time of filing. Another study confirms what we’ve seen in calls to our office for assistance – patients in financial distress will prioritize paying medical bills over almost any other debt, including credit cards and home equity loans. It is likely that the impact of medical bills in bankruptcies is under-counted. Reforms will not work without vigilant oversight of the insurance industry and meaningful, affordable coverage.
Ellen Andrews

SustiNet passes Public Health Committee

Yesterday the Public Health Committee passed the SustiNet bill on a party line vote. Even legislators who voted against the bill praised most of the provisions and the intent of the bill. Concerns centered on potential state liability (although the bill requires SustiNet to be self-sustaining), that it will “take over” Connecticut’s insurance market (only about 15% of residents are expected to enroll), that it doesn’t do enough to reduce climbing health care costs (it’s a start), that it isn’t necessary given national health reform (it really is necessary to have a public option if we are going to require everyone to buy insurance), that we are moving too fast and should wait to see what happens to federal reform (interesting given other concerns that we have waited too long to address the problems), and that the timeline for implementation of patient-centered medical homes is too ambitious (we are behind other states, but many CT practices are already in the process of becoming certified). Substitute language removed medical malpractice protection for providers who follow evidence-based medicine, makes it clear that DSS will be the single state agency for Medicaid, and makes including individuals in SustiNet (the point of the bill) contingent on a feasibility study. The bill now moves to the Insurance and Real Estate Committee.
Ellen Andrews

CT residents middle of the pack in well-being

A Gallup poll of Americans finds that CT ranked 22nd among states in well-being in 2009, down from 19th in 2008. The detailed poll includes measures of learning, stress, and happiness. Among CT cities, Norwich is highest in well-being, closely followed by Bridgeport and Hartford: New Haven is very far behind. (It appears our work environment here in New Haven is dragging us down.) An interactive map (I can’t resist them) shows how Americans score by Congressional district overall and across twenty categories including job satisfaction, fruits and vegetables. CT does well on dental visits and adequate food and shelter, not so well on stress and whether our communities are improving. The happiest American, according to Gallup and the NY Times, is Alvin Wong, a tall, upper income, Asian-American, observant Jewish man over age 65 with children living in Hawaii.
Ellen Andrews

Quality of care in CT remains high

AHRQ’s new 2010 Health Care Quality and Disparities reports find that our state is among the best in the overall quality of care we receive, however we lag behind the rest of New England in prevention and acute treatment and behind others for chronic disease management and health outcomes. Nationally, urban - rural disparities in access to care were greater than in quality of care. The report includes constructive highlights from successful initiatives that can be replicated in other communities including my favorites – patient and family engagement, overtreatment, and care coordination.
Ellen Andrews

March Webquiz – children’s health in CT

Test your knowledge of children’s health in CT. Take the March CT Health Policy webquiz.

Sales call illustrates the benefits of PCCM and a new way of doing business in Medicaid

I had a call yesterday that illustrates the power and potential of CT Medicaid’s new self-insured PCCM model. A representative from a national medical service company wanted to learn more about business opportunities in our state under the new arrangement. They provide medical supplies for people with a common chronic condition and have non-clinical technicians go to patients’ homes to demonstrate how to use them. He wanted to bring a team of people from their company to make a presentation to “the company running the program”. He claimed great success with his products and services and wanted to know how they could get access to the market. I said that his company needs to become a Medicaid provider, and I was sure that DSS could help him with that. He informed me that they are already certified as Medicaid providers, but he wanted to make a presentation to a central, corporate group that would authorize them access to every Medicaid patient with that condition. I said that in PCCM each patient-centered medical home team, especially the patient, decides on the right array of services, how to deliver them, and from what vendor based on each patient’s individual care plan – not a corporate entity. He still didn’t get it – he said they usually make presentations to HMOs and they gain entre to patients without going through providers or consumers. I told him under PCCM he’d have to make thousands of presentations to every provider and consumer in the state. I still don’t know if he fully understands how this is supposed to work, and he definitely doesn’t appreciate the benefits, but he finally understood that this sales call wasn’t going to be productive.
Ellen Andrews

ACA caps on consumer spending would have helped 139,100 CT consumers this year

A report released today by Families USA finds that caps on what consumers have to pay for health care in the Affordable Care Act, if they were in effect this year, would have helped 139,100 Connecticut residents and saved families almost $250 million. Adjusted to today’s dollars, the caps limit consumers’ health costs over $5,950 for individuals and $11,900 for families. The large majority of families who reach these caps include workers, most employed full time. Over one third work in small businesses with fewer than 25 workers. Because the caps are not yet in place, this year families of small business workers in our state will spend over $100 million more than the caps. These caps are critical to protecting families struggling in this economy from catastrophic medical bills, bankruptcy, foreclosure and credit card debt – one of many essential protections in the Affordable Care Act for Connecticut working families.
Ellen Andrews